The present invention generally relates to surgical apparatus and methods. More specifically, the invention relates to a surgical instrument and method for use with a robotic surgical system, the instrument including an ultrasonic probe.
Minimally invasive surgical techniques generally reduce the amount of extraneous tissue damage during surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. One effect of minimally invasive surgery, for example, is reduced post-operative hospital recovery times. Because the average hospital stay for a standard surgery is typically significantly longer than the average stay for an analogous minimally invasive surgery, increased use of minimally invasive techniques could save millions of dollars in hospital costs each year. Patient recovery times, patient discomfort, surgical side effects, and time away from work can also be reduced by increasing the use of minimally invasive surgery.
In theory, a significant number of surgical procedures could potentially be performed by minimally invasive techniques to achieve the advantages just described. Only a small percentage of procedures currently use minimally invasive techniques, however, because certain instruments, systems and methods are not currently available in a form for providing minimally invasive surgery.
Traditional forms of minimally invasive surgery typically include endoscopy, which is visual examination of a hollow space with a viewing instrument called an endoscope. One of the more common forms of endoscopy is laparoscopy, which is visual examination and/or treatment of the abdominal cavity. In traditional laparoscopic surgery a patient""s abdominal cavity is insufflated with gas and cannula sleeves are passed through small incisions in the musculature of the patient""s abdomen to provide entry ports through which laparoscopic surgical instruments can be passed in a sealed fashion. Such incisions are typically about xc2xd inch (about 12 mm) in length.
The laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field and working tools defining end effectors. Typical surgical end effectors include clamps, graspers, scissors, staplers, and needle holders, for example. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by a long extension tube, typically of about 12 inches (about 300 mm) in length, for example, so as to permit the surgeon to introduce the end effector to the surgical site and to control movement of the end effector relative to the surgical site from outside a patient""s body.
To perform a surgical procedure, a surgeon typically passes the working tools or instruments through the cannula sleeves to the internal surgical site and manipulates the instruments from outside the abdomen by sliding them in and out through the cannula sleeves, rotating them in the cannula sleeves, levering (i.e., pivoting) the instruments against the abdominal wall and actuating the end effectors on distal ends of the instruments from outside the abdominal cavity. The instruments normally pivot around centers defined by the incisions which extend through the muscles of the abdominal wall. The surgeon typically monitors the procedure by means of a television monitor which displays an image of the surgical site captured by the laparoscopic camera. Typically, the laparoscopic camera is also introduced through the abdominal wall so as to capture the image of the surgical site. Similar endoscopic techniques are employed in, for example, arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like.
Although traditional minimally invasive surgical instruments and techniques like those just described have proven highly effective, newer systems may provide even further advantages. For example, traditional minimally invasive surgical instruments often deny the surgeon the flexibility of tool placement found in open surgery. Difficulty is experienced in approaching the surgical site with the instruments through the small incisions. Additionally, the added length of typical endoscopic instruments often reduces the surgeon""s ability to feel forces exerted by tissues and organs on the end effector. Furthermore, coordination of the movement of the end effector of the instrument as viewed in the image on the television monitor with actual end effector movement is particularly difficult, since the movement as perceived in the image normally does not correspond intuitively with the actual end effector movement. Accordingly, lack of intuitive response to surgical instrument movement input is often experienced. Such a lack of intuitiveness, dexterity and sensitivity of endoscopic tools has been found to be an impediment in the increased the use of minimally invasive surgery.
Minimally invasive robotic (or xe2x80x9ctelesurgicalxe2x80x9d) surgical systems have been developed to increase surgical dexterity as well as to permit a surgeon to operate on a patient in an intuitive manner. Telesurgery is a general term for surgical operations using systems where the surgeon uses some form of remote control, e.g., a servomechanism, or the like, to manipulate surgical instrument movements, rather than directly holding and moving the tools by hand. In such a telesurgery system, the surgeon is typically provided with an image of the surgical site on a visual display at a location remote from the patient. The surgeon can typically perform the surgical procedure at the location remote from the patient whilst viewing the end effector movement on the visual display during the surgical procedure. While viewing typically a three-dimensional image of the surgical site on the visual display, the surgeon performs the surgical procedures on the patient by manipulating master control devices at the remote location, which master control devices control motion of the remotely controlled instruments.
Typically, such a telesurgery system can be provided with at least two master control devices (one for each of the surgeon""s hands), which are normally operatively associated with two robotic arms on each of which a surgical instrument is mounted. Operative communication between master control devices and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor which relays input commands from the master control devices to the associated robotic arm and instrument assemblies and from the arm and instrument assemblies to the associated master control devices in the case of, e.g., force feedback, or the like. One example of a robotic surgical system is the DAVINCI(trademark) system available from Intuitive Surgical, Inc. of Mountain View, Calif.
Just as robotic surgical systems have been found advantageous, so too has use of ultrasound energy in surgery been found beneficial. A number of patents disclose ultrasonic treatment instruments for both open surgery and manually-performed endoscopic surgery. These patents include U.S. Pat. No. 6,056,735 issued May 2, 2000, entitled Ultrasound Treatment System; U.S. Pat. No. 6,066,151 issued May 23, 2000, entitled Ultrasonic Surgical Apparatus; U.S. Pat. No. 6,139,561 issued Oct. 31, 2000, entitled Ultrasonic Medical Instrument; U.S. Pat. No. 6,165,191 issued Dec. 26, 2000, entitled Ultrasonic Treating Tool; and U.S. Pat. No. 6,193,709 issued Feb. 27, 2001, entitled Ultrasonic Treatment Apparatus. The full disclosure of each of these patents is incorporated herein by reference.
A typical ultrasound treatment instrument for manual endoscopic surgery is the SonoSurg(copyright) instrument model T3070 made by Olympus Optical Co., Ltd., of Tokyo, Japan. Other examples of manually operated ultrasound treatment instruments are the Harmonic Scalpel(copyright) LaparoSonic(copyright) Coagulating Shears, made by Ethicon Endo-Surgery, Inc, of Cincinnati, Ohio.; and the AutoSonix(copyright) Ultra Shears(copyright) made by United States Surgical Corporation of Norwalk, Conn. Such an ultrasound treatment instrument may comprise ultrasonic transducers for generating ultrasonic vibrations; a handpiece including the ultrasonic transducers and serving as an operation unit; a generally elongate probe connected to the ultrasonic transducers and serving as a vibration conveyer for conveying ultrasonic vibrations to a distal end effector member or tip used to treat a living tissue; a sheath serving as a protective member for shielding the probe. The instrument typically includes a movable holding, grasping or gripping end effector member pivotally opposed to the distal tip and constituting a movable section which clamps a living tissue in cooperation with the distal tip; an operating mechanism for moving the grasping member between a closed position in which the grasping member engages the distal tip of the vibration transmitting member and an open position in which the grasping member is separated from distal tip portion. The operating mechanism includes handle portions for manipulation and actuation by a surgeon""s hands.
Surgical ultrasound instruments are generally capable of treating tissue with use of frictional heat produced by ultrasonic vibrations. For example, the heat may be use to cut and/or cauterize tissue. With many currently available instruments, tissue may first be grasped by an ultrasound surgical device and then ultrasound energy may be delivered to the tissue to cut, cauterize or the like. Ultrasound instruments provide advantages over other cutting and cauterizing systems, such as reduced collateral tissue damage, reduced risk of unwanted burns, and the like. Currently, however, ultrasound instruments for use with a robotic surgical system are not available.
Therefore, a need exists for a surgical instrument, for use with a robotic surgical system, that provides ultrasound energy at a surgical site. Such an instrument would allow the advantages of ultrasound and minimally invasive robotic surgery to be combined.
Surgical apparatus and methods for enhancing robotic surgery generally include a surgical instrument with an elongate shaft having an ultrasound probe, an end effector at the distal end of the shaft, and a base at the proximal end of the shaft. The end effector includes an ultrasound probe tip and the surgical instrument is generally configured for convenient positioning of the probe tip within a surgical site by a robotic surgical system. Ultrasound energy delivered by the probe tip may be used to cut, cauterize, or achieve various other desired effects on tissue at a surgical site. By providing ultrasound energy via a robotic surgical instrument for use with a robotic surgical system, the apparatus and methods of the present invention enable the advantages associated with ultrasound to be combined with the advantages of minimally invasive robotic surgery.
In accordance with one aspect, the present invention provides a method of performing a robotic surgical procedure on a patient. Generally, the method includes coupling a surgical instrument with a robotic surgical system, the surgical instrument having a distal end with an ultrasound probe tip, positioning with the robotic surgical system the ultrasound probe tip in contact with tissue at a surgical site in the patient, and delivering ultrasound energy to the tissue with the ultrasound probe tip. Optionally, the distal end of the surgical instrument further includes a gripping member. In embodiments including a gripping member, the method further includes transmitting at least one force from the robotic surgical system to the gripping member and moving the gripping member with the at least one force to hold a portion of the tissue between the gripping member and the ultrasound probe tip.
In some embodiments, the method further includes transmitting the at least one force from an interface member on the robotic surgical system to a first rotatable shaft on the surgical instrument, the first rotatable shaft being coupled to a second rotatable shaft by a cable, the cable being coupled to an actuator rod, and the actuator rod being coupled to the gripping member, wherein the at least one force causes the first shaft, the second shaft and the cable to rotate, causing the actuator rod to move the gripping member. In other embodiments, the method further includes releasing the portion of tissue after delivering a desired amount of ultrasound energy to the portion of tissue. In various embodiments, the method also includes using the ultrasound probe tip to cut the tissue, cauterize the tissue, or both.
In another aspect, the present invention provides a surgical instrument for use with a robotic surgical system. Generally, the surgical instrument includes an elongate shaft having a proximal end and a distal end, the elongate shaft including an ultrasound probe, an end effector disposed at the distal end, the end effector including an ultrasound probe tip of the ultrasound probe, and a base disposed at the distal end for connecting the surgical instrument to the robotic surgical system. Optionally, the elongate shaft may be configured to rotate in relation to the base about an axis drawn from the proximal end to the distal end.
Also optionally, the base of the surgical instrument may include: at least two shafts rotatably mounted within the base, each of the shafts having two ends, at least one of the ends of one of the shafts protruding from the base to engage a corresponding interface member on the robotic surgical system; at least two spools, each spool being mounted on one of the shafts; at least one cable for connecting two of the spools; and a rotating member coupled to the cable and to the elongate shaft, the rotating member being configured to rotate the elongate shaft in response to movements of the interface member, the at least two shafts, the at least two spools and the at least one cable.
In some embodiments, the end effector of the surgical instrument includes a gripping member hingedly attached to the end effector for gripping tissue in cooperation with the ultrasound probe tip. In those embodiments, the surgical instrument may optionally include at least one force transmitting member for transmitting one or more forces between the robotic surgical system and the gripping member to move the gripping member. In various embodiments, the transmitting member may include: at least two shafts rotatably mounted within the base, each of the shafts having two ends, at least one of the ends of one of the shafts protruding from the base to engage a corresponding interface member on the robotic surgical system; at least two spools, each spool being mounted on one of the shafts; at least one cable for connecting two of the spools; and an actuator rod coupled to the cable and to the gripping member and extending through the elongate shaft, the actuator rod being configured to move the gripping member in response to movements of the interface member, the at least two shafts, the at least two spools and the at least one cable.
In some embodiments, the base of the surgical instrument includes an ultrasound source connector for connecting the ultrasound probe to an external ultrasound source. In other embodiments, the base includes an internal ultrasound source for providing ultrasound energy to the ultrasound probe.
Generally, the ultrasound probe of the surgical instrument may include various components. For example, in one embodiment the probe includes an ultrasound transducer for generating ultrasonic vibrations and one or more amplifying horns for amplifying the ultrasonic vibrations.
In some embodiments, the ultrasonic probe assembly may be arranged to be axially movable within the elongate shaft, and the proximal portion of the probe may be mechanically coupled to one or more movable interface members so that the probe is movable in a reciprocating manner in response to movement of the interface member. The distal portion of the probe assembly may be coupled to the grip member, so that the grip opens or closes as the probe moves axially. In this manner the movable probe assembly may serve the function of a grip actuator rod in addition to transmitting ultrasound energy to the surgical site.
Certain exemplary surgical instrument embodiments having aspects of the invention may be described or characterized in general terms as comprising an instrument probe assembly having a distal end configured to be insertable into a patient""s body through a small aperture, such as a minimally invasive surgical incision or the like, typically defined by a cannula or trocar. The instrument probe assembly comprises a proximal end coupled to an instrument base. The instrument probe assembly typically is elongate, having an axis extending between the distal and proximal probe ends, and may have a generally straight or shaft-like medial portion. In alternative embodiments, the medial probe portion may be curved and/or may be flexible in shape relative to the axis. The instrument base includes an instrument interface assembly which is engagable to a robotic surgical system. Preferably, the instrument interface assembly is removably engageable to the robotic surgical system, and may include a latch mechanism permitting quick connection and disconnection.
The instrument interface assembly is engagable with provides for one or more instrument actuation inputs from the robotic surgical system in response to an input by an operator (i.e., an activation input to the instrument, being an activation output from the robotic surgical system, which in turn is a response by the robotic control system to an operator control input). Preferably the one or more instrument activation inputs include an input to activate at least one degree of freedom of motion of the all or a portion of the instrument probe assembly relative to the instrument base. The activation input may be a mechanical input, an electrical input, a magnetic input, a signal input, an optical input, a fluidic input, a pneumatic input, and the like, or a combination of these, without departing from the spirit of the invention.
In certain exemplary embodiments of surgical instruments having aspects of the invention, at least one activation input includes an operative engagement of a rotatable interface body (activation interface body) of the robotic surgical system with a corresponding rotatable shaft (instrument interface body or instrument interface shaft) of the instrument interface assembly in the instrument base. The rotatable shaft is in turn mechanically coupled by one or more drive elements to all or a portion of the to the instrument probe assembly, so as to impart a corresponding degree of freedom to all or a portion of the instrument probe assembly relative to the base.
As described above, in alternative embodiments another type of activation modality may be substituted for the rotatable interface body of the robotic surgical system. For example, an electrical power/control interface (e.g., including a multi-pin connector) may be included in the interface assembly to transmit electrical power and/or control signals from the robotic surgical system to actuate a motor pack mounted in the instrument base, the motor pack output may in turn may be coupled to the instrument probe assembly so as to impart one or more corresponding degrees of freedom to all or portions of the instrument probe assembly relative to the base. The motor pack may include one or more electrical motors, transmission gearing, position encoders, torque sensors, feedback sensors, and the like, and may transmit feedback or sensor signals to the robotic surgical system via the interface.
In certain exemplary embodiments of surgical instruments having aspects of the invention, the at least one degree of freedom of motion in response to an activation input from the robotic surgical system includes the pivotal activation of a clamp or grip member of an end effector coupled to the distal probe end. In certain exemplary embodiments, the at least one degree of freedom of motion includes the axial rotation of at least the major portion of the instrument probe assembly about its axis relative to the instrument base.
In alternative embodiments other types of degrees of freedom of motion of all or a portion of the instrument probe assembly may be activated by engagement of the robotic surgical system. For example, the instrument probe assembly may include at least one distal joint to controllably orient the distal probe end relative to the probe axis, such as a wrist-like rotational or pivotal joint supporting a distal end effector. In another example, the probe medial portion may have a flexible section which is controllably variable in shape by one or more degrees of freedom, being driveable by longitudinal tendon members extending within the instrument probe assembly.
In these alternative embodiments, the instrument interface assembly is coupled to drive members of the instrument probe assembly to activate such degrees of freedom and is engagable with the robotic surgical system to receive activation inputs to activate such drive members. Further examples of alternative instrument embodiments include instrument probe assemblies having controllable shape-memory components, movable piezo-electric drive elements, hydraulic drive elements, and the like, or combinations of these. As describe above, the robotic activation input may include a corresponding activation modality suitable for any of these instrument probe assembly movement modalities, without departing from the spirit of the invention.
To reduce costs and for manufacturing convenience, the instrument may include OEM parts. For example, the instrument probe assembly may include parts or components generally similar or identical to parts or components (OEM components) of current or future commercially-available endoscopic instruments for surgical or diagnostic uses (OEM medical systems), including manually operated instruments. The surgical instruments of the invention may perform some or all of the functions of such OEM medical systems. For example, the instrument probe assembly of the surgical instruments of the invention may include OEM components of ultrasound treatment probes, electrocautery probes, ultrasound diagnostic probes, diagnostic imagery probes. In further examples, the instrument probe assembly may include suitable OEM components of biopsy probes, suction probes, substance injection probes, surgical accessory application probes, stapler probes, tissue grasping and cutting probes, and the like. Likewise, the instrument probe assembly may combine more than one of the medical functions of the above described instruments.
In certain exemplary embodiments of surgical instruments having aspects of the invention, the instrument probe assembly comprises a distally disposed end effector coupled to the probe distal end to engage tissue employing a medical energy modality. For example, the instrument probe assembly may include a conduction element or conduction core coupled to the end effector; and extending along the probe axis. The conduction element may be configured and composed to communicate the medical energy between the end effector and a medical energy source. For example, the instrument may include one or more energy connector devices coupled to the conduction element, the connector devices being engagable operatively communicate to a power, signal and/or control system external to the instrument to enable medical functions of the instrument (medical energy system).
The medical energy system may include a power, signal and/or control system which is distinct from the robotic surgical system, such as the power, signal and/or control system of an OEM medical system. Such medical energy systems may likewise be responsive to a control input of an operator. For example, instrument embodiments of the invention may include a cable connector configured to connect to an OEM surgical ultrasound generator, an OEM electrocautery generator, and the like.
Optionally, the energy connector device of the instrument may be configured for xe2x80x9cwirelessxe2x80x9d engagement with the medical energy system, so that operative reception and/or transmission of the medical energy signal may be by non-contact communication with the medical energy system.
In a further option, the medical energy system may be integrated with the robotic surgical system. Optionally, the respective energy connector devices may be integrated with the instrument interface assembly, and optionally operator input devices of the medical energy system may be integrated with the operator input devices of the robotic surgical system.
In the particular instrument examples shown in the figures, the medical energy modality is ultrasound energy for tissue treatment, and the instrument probe assembly comprises an ultrasonic treatment assembly or ultrasonic treatment probe. The ultrasonic treatment probe includes a transducer coupled to an ultrasonic acoustical conduction core, the transducer preferably being supported at least partially by the instrument base. The medical energy system comprises an OEM ultrasonic generator. The interface connector device includes a cable connector mounted to the base and engagable with a cable to communicate with an OEM ultrasonic generator. The ultrasonic treatment probe includes a probe tip coupled to the conduction core and configured to engage tissue and controllably transmit ultrasound energy to the engaged tissue.
As described above, in alternative embodiments an instrument probe assembly employing another type of medical energy modality may be included. For example, the instrument probe assembly may comprise an electrosurgical treatment probe including a electrical conduction element coupled to an end effector, and the base may include a connector interface coupled to the electrocautery treatment probe, and configured to be connectable to an OEM electrosurgical generator. In further examples, the instrument probe assembly may include a conduction element for communicating a diagnostic energy modality, e.g., signals to and/or from an end effector having an diagnostic ultrasound transducer or other diagnostic sensor and or transmitter.